Table 2 Key considerations and strategies leading to implementation

From: Large language models in global health

Domain

Key considerations and strategies

Critical appraisal framework

Broad sociotechnical context

▪ Alignment with goals and incentives (for example, health-related SDGs)

▪ Industry partnerships (for example, multinational technology companies)

▪ Attitudes towards technology

▪ Equitability and generalizability under different contexts (for example, situations of fragility, conflict and violence)

Local context

▪ Medical practice and clinical workflow

▪ Local infrastructure and existing technology platforms

▪ Accessibility by users and patients

People

▪ Digital and AI literacy

▪ Mass upskilling programmes (for example, massive open online courses)

▪ Redesign of medical curricula and introduction of new programmes

LLM technology

▪ Computationally efficient models

▪ Open-weight or open-source models with local fine-tuning

▪ Benchmarking with curated local datasets (for example, AfriMed-QA)

Supported by

Evidence-based implementation

▪ Conduct of real-world pragmatic trials

▪ Partnerships with implementation research centres

▪ Consideration of the scalability and sustainability of the project

▪ Evaluation of implications to the local workforce and environment

Global governance and regulation

▪ Global harmonization on regulations (for example, African Medicines Regulatory Harmonization)

▪ Responsible implementation and use (for example, GI-AI4H)

▪ Postimplementation evaluation and monitoring

Outcome achieved

Value realization

▪ Workforce multiplier

▪ Improved health and well-being

▪ Reduced health inequities

  1. The domains outlined within this critical appraisal framework represent overarching categories of implementation strategies and are probably nonexhaustive. Systematic appraisal of these domains can inform the design of pragmatic studies and guide the evidence-based implementation and scaling of LLM-enabled clinical tools. Real-world evaluations, complemented by the establishment of governance frameworks, regulatory pathways and postimplementation surveillance infrastructure, are essential to realizing the full value of LLMs in global health.
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